IMAGE  EVALUATION 
TEST  TARGET  (MT-3) 


1.0 


MilM    12.5 


I.I 


'"  lis  IIIIIM 


U 
I.     ^ 


1.8 


^  ,•'■■■             ^      .    , 

1.25      1.4     1 1 A 

M 6"     

► 

PhotDgraphic 

Sciences 
Corporation 


4^ 


C\^.  >> 


^9) 


23  WEST  MAIN  STREET 

WEBSTER,  N.Y.  14580 

(716)873-4503 


5L'^"     ".A.  ^ 


^:;j^^^' 


CIHM/ICMH 

Microfiche 

Series. 


CIHIVJ/iCiVIH 
Collection  de 
microfiches. 


Canadian  Institute  for  Historical  Microreproductions  /  Institut  Canadian  de  microreprodMctions  historiques 


Technical  and  Bibliographic  Notes/Notes  techniques  et  bibliographiques 


" 


The  Institute  has  attempted  to  obtain  the  best 
original  copy  available  for  filming.  Features  of  this 
copy  which  may  be  bibliographically  unique, 
which  may  alter  any  of  the  images  in  the 
reproduction,  or  which  may  significantly  change 
the  usual  method  of  filming,  are  checked  below. 


0 


Coloured  covers/ 
Couverture  de  coul^ur 


I      I    Covers  damaged/ 


D 


D 


D 


D 


D 


Couverture  endommag6e 


Covers  restored  and/or  laminated/ 
Couverture  restaurde  et/ou  pelliculee 


I      I    Cover  title  missing/ 


Le  titre  de  couverture  manque 


I      I    Coloured  maps/ 


Cartes  gdographiques  en  couieur 

Coloured  init  (i.e.  other  than  blue  or  black)/ 
Encre  de  couieur  (i.e.  autre  que  bleue  ou  noire) 


□   Coloured  plates  and/or  illustrations/ 
Planches  et/ou  illustrations  en  couieur 

□    Bound  with  other  material/ 
Relid  avec  d'autres  documents 


Tight  binding  may  cause  shadows  or  distortion 
along  interior  margin/ 

Lareliure  serr6e  peut  causer  de  I'ombre  ou  de  la 
distortion  ie  long  de  la  marge  intdrieure 

Blank  leaves  added  during  restoration  may 
appear  within  the  text.  Whenever  possible,  these 
have  been  omitted  from  filming/ 
II  se  peut  que  certaines  pages  blanches  ajout6es 
lors  d'une  restauration  apparaissent  dans  le  texte, 
mais,  iorsque  cela  6tait  possible,  ces  pages  n'ont 
pas  6t6  film6es. 

Additional  comments:/ 
Commentaires  suppl6mentaires; 


L'Institut  a  microfilm^  le  meilleur  exemplaire 
qu'il  lui  a  6t4  possible  de  se  procurer.  Les  details 
de  cet  exemplaire  qui  sont  peut-§tre  uniques  du 
point  de  vue  bibliographique,  qui  peuvent  modifier 
une  image  reproduite,  ou  qui  peuvont  exiger  une 
modification  dans  la  m6thode  normale  de  filmage 
sont  indiqu^s  ci-dessous. 


I      I    Coloured  pages/ 


Pages  de  couieur 

Pages  damaged/ 
Pages  endommagdes 


□    Pages  restored  and/or  laminated/ 
Pages  restaur6es  et/ou  peliiculdes 

n    Pages  discoloured,  stained  or  foxed/ 
Pages  ddcolordes.  tachetdes  ou  piqudes 

0    Pages  detached/ 
Pages  ddtachdes 

r^l#»  Showthrough/ 
I— IJ   Transparence 

□    Quality  of  print  varies/ 
Quality  inigaie  de  I'impression 

□    Includes  supplementary  material/ 
Comprend  du  materiel  suppldmentaire 

nOnly  edition  available/ 
Seule  Edition  disponible 


D 


Pages  wholly  or  partially  obscured  by  errata 
slips,  tissues,  etc..  have  been  refilmed  to 
ensure  the  best  possible  image/ 
Les  pages  totalement  ou  partiellement 
obscurcies  par  un  feuillet  d'errata.  une  pelure, 
etc.,  ont  6t6  fiimdes  d  nouveau  de  fagon  d 
obtenir  la  meilleure  image  possible. 


This  item  is  filmed  at  the  reduction  ratio  checked  below/ 

Ce  document  est  fiimd  au  taux  de  reduction  indiquA  ci-dessous. 

10X  14X  18X  22X 


26X 


30X 


• 


12X 


16X 


20X 


24X 


28X 


32X 


iW 


The  copy  filmed  here  has  been  reproduced  thanks 
to  the  generosity  of: 

Metropolitan  Toronto  Library 
Canadian  History  Department 


L'exempiaire  film*  fut  reproduit  grice  A  la 
gAnArosit6  de: 

Metropolitan  Toronto  Library 
Canadian  History  Department 


The  images  appearing  here  are  the  best  q  lallty 
possible  considering  the  condition  and  legibility 
of  the  original  copy  and  in  iceeping  with  the 
filming  contract  specifications. 


Les  images  suivantes  ont  6t6  reproduites  avec  le 
plus  grand  soin,  compte  tenu  de  la  condition  et 
de  la  nettet6  de  l'exempiaire  film*,  et  en 
conformity  avec  les  conditions  du  contrat  de 
fiEmage. 


Original  copies  in  printed  paper  covers  are  filmed 
beginning  with  the  front  cover  and  ending  on 
the  last  page  with  a  printed  or  illustrated  impres- 
sion, or  the  back  cover  when  appropriate.  All 
other  original  copies  are  filmed  beginning  on  the 
first  page  with  a  printed  or  illustrated  impres- 
sion, and  ending  on  the  last  page  with  a  printed 
or  Illustrated  impression. 


Les  exemplaires  originaux  dont  la  couvertur^  on 
papier  est  imprimie  sont  fillm6s  en  commenpaiit 
par  le  premier  plat  et  en  terminunt  soit  par  la 
dernlAre  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration,  soit  par  ie  second 
plat,  salon  ie  cas.  Tous  les  autres  exemplaires 
originaux  sont  filmds  en  commenpant  par  la 
premidre  page  qui  comporte  une  empreinte 
d'impression  ou  d'iliustration  et  en  terminant  par 
la  dernidre  page  qui  comporte  une  telle 
empreinte. 


The  last  recorded  frame  on  each  microfiche 
shall  contain  the  symbol  ^^>  (meaning  "CON- 
TINUED"), or  the  symbol  V  (meaning  "END"), 
whichever  applies. 


Un  des  symboles  suivants  apparaTtra  sur  la 
dernidre  image  de  cheque  microfiche,  selon  le 
cas:  le  symbols  — ►  signifie  "A  SUIVRE",  le 
symbols  V  signifie  "FIN". 


Maps,  plates,  charts,  etc.,  may  be  filmed  at 
different  reduction  ratios.  Those  too  large  to  be 
entirely  included  in  one  exposure  are  filmed 
beginning  in  the  upper  left  hand  corner,  left  to 
right  and  top  to  bottom,  as  many  frames  as 
required.  The  following  diagrams  illustrate  the 
method: 


Les  cartes,  planches,  tableaux,  etc.,  peuvent  dtre 
filmte  d  des  taux  de  reduction  diffirents. 
Lorsque  le  document  est  trop  grand  pour  Atre 
reproduit  en  un  seul  cliche,  ii  est  film*  d  partir 
de  I'angle  sup6rieur  gauche,  de  gauche  it  droite, 
et  de  haut  en  bas,  en  prenant  le  nombre 
d'images  n6cessaire.  Les  diagiammes  suivants 
illustrent  la  m^thode. 


1 

2 

3 

32X 


1 

2 

3 

4 

5 

6 

BRAIN  LESIONS  AND  FUNCTIONAL 

RESULTS. 


^ 


-»o;«4o<>- 


BY    DANIEl.    TLARK,    ]»I.    D., 

Medical  Superintendent  Asylum  lor  Insane,  Toronto ; 
Member  of   Medic-al    Council,  Ex-President   of   College  of    Physicians  and 

Surgeons,  Ontario, 


-«o:«;o«- 


From.  the  Amencan  Jovrmil  of  Lhsanity^  for  January,  1881. 


|pp|PfP«ipi«i"ju yi  .,«"  "jiii«-""ff»,»ww'"«n'f .""... 


."fill  I  'f  "    J«!  |i4P!lpp|!*iii'iii"(  I 


Cr'T™'^^^'"*'" 


15 


PW^IWW"W^ 


brmn  lesions  and  functional 

results: 


EY    DANIFL    CLATIK,    Jf.    D., 

Medical  Superintendent  Asylum  for  InHane,  Toronto; 

Member  of   Medical    Council,  Ex-President   of    College  of   Physiciana  and 

Surgeons,  Ontario. 


Thei'e  is  great  danger  in  medical  research  to  accejit 
as  theories  preconceived  notions  based  on  a  few  isolated 
cases,  and  then  to  fortify  these  dubious  inteipretations 
of  physical  or  mental  phenomena  by  dragging  in,  neck 
and  heels,  every  iota  which  seems  to  corroborate  our 
views.  On  the  other  hand,  the  ardent  but  discreet 
investigator  will  adopt  no  great  general  principles  until 
he  has  at  his  command  sufficient  data  upon  which  to 
base  them,  beyond  the  bare  presumption  of  vague 
probabilities.  liichet,  in  his  "  Histology  and  Physiology 
of  the  Cerebral  Convolutions,"  says  in  the  preface : 
"  There  is  nothing  more  baneful  than  to  treat  hypotheses 
as  certainties.  On  the  contrary,  when  serious  criticism 
has  revealed  the  defects  and  feebleness  of  an  experiment, 
a  real  service  has  been  rendered,  for  it  mav  incite  to 
new  experiments  and  unequivocal  conclusions.  Induc- 
tions from  probabilities  or  ill-demonstrated  experiments 
are  unreliable,  and  intelligent  skepticism  is  more  valua- 
ble to  the  advance  of    science  than  unbridled  enthu- 


siasm. 


V 


*Read  before  the  Canada  Medical  Association,  at  Ottawa,  September  1, 1880, 


This  honest  expression  of  such  an  investigator  should 
lead  us  to  pause  before  drawing  conclusions  and  estab- 
lishing theories  with  insufficient  proofs.  It  will  be  seen 
in  the  cases  adduced  of  losion  of  the  brains  that  this 
organ  can  stand  more  rough  treatment  in  many  of  its 
parts  than  almost  any  other  organ  of  the  body.  In 
fact,  such  lacerai^ion  of  its  delicate  structures  can  take 
place  without  any  serious  mental  or  physical  disturb- 
ance, that  we  almost  unconsciously  take  for  granted  that 
many  parts  of  it  must  be  of  secondary  importance  in 
the  animal  economy.  It  is  true  that  a  large  majority 
of  those  injured  in  the  brain  are  afterwards  afflicted 
with  such  diseases  as  epilepsy,  paralysis,  head  distress, 
loss  of  memory,  and  such  like,  yet  it  is  remarkable  how 
many  examples  of  the  most  extensive  lesions  of  the 
brain  can  be  found  with  no  such  results.  In  a  mon- 
ograph published  by  me  a  short  time  ago  I  endeavored 
to  show  that  localization  of  functional  power  resided 
only  in  the  basal  ganglia,  and  that  the  masses  of  cer- 
ebral substance  above  them  were  only  depositories  of 
nervous  energy.  If  this  qpinion  be  based  on  a  physio- 
logical fact,  it  would  help  to  solve  this  enigma.  It  is 
well  known  by  all  medical  readers  that  a  sharp  contro- 
versy had  been  carried  on,  and  antagonistic  opinions 
have  been  uttered  by  the  leaders  of  thought  in  our  pro- 
fession on  the  functions  of  the  convolutions  of  the  brain. 
The  brain  has  been  mapped  out  with  the  accuracy  of  the 
streets  of  a  city,  and  each  disti'ict  has  been  allotted  its 
own  work  to  do.  Although  no  dividing  line  exists  in 
the  substance  of  the  brain,  yet  the  comparatively  slen- 
der divisions  of  many  of  the  sulci  are  made  to  be 
boundaries  of  functional  energy  in  which  great  differ- 
ences of  operation  exist.  It  is  not  the  province  of  this 
paper  to  take  up  this  subject  in  detail,  but  rather  to 
show  by  the  record  of  cases  how  foreign  bodies  and 


^d\ 


■**■     .^ 


'    w 


8 

(liHease  can  vlrtiially  destroy  many  of  these  so-called 
centers,  \vitliout  any  commensurate  fnnctional  disturb- 
ance such  as  niiglit  be  expected  if  these  parts  were 
distinct  organs;  also  to  show  that  mentality  is  not  in- 
terfered with  in  these  cases  to  the  extent  which  at  one 
time  we  were  led  to  l)elieve.  The  psychical  results 
would  be  a  good  nut  for  the  "l)nmpologist"  to  crack,  in 
these  days  of  infidelity  in  the  doctrines  of  Gall  and 
Spurzheim.  All  anatomists  know,  that  although  the 
fissures  of  the  brain  in  man  maintain  a  certain  degree  of 
uniformity  in  direction  auil  outline,  yet  the  differences 
in  detail  are  considerable.  It  will  also  be  observed 
that  these  fissures  do  not  make  distinct  divisions  of  the 
surface.  The  even  continuity  of  the  surface  of  every 
convolution  by  means  of  an  isthmus,  (so  to  speak),  at 
the  extremities  and  sides  of  each,  indicate  no  striking 
dividing  line  between  each  of  them.  The  dips  in  the 
grey  matter  lying  underneath  these  fissures  and  in  prox- 
imity to  the  white  substance,  show  that  a  certain  degree 
of  uniformity  in  quantity  of  grey  matter  is  present 
throughout  the  periphery  of  the  brain.  It  is  true  that 
differences  in  cell  formation  are  seen  in  the  various 
layers  of  the  cortical  substance,  but  these  cellular  dis- 
tinctions are  found  only  in  each  layer.  There  is  no 
physiological  distinction  found  in  the  various  convolu- 
tions distinct  from  one  another  to  account  for  the  varied 
functions  in  these  ^  jailed  motor  centers,  as  claimed  by 
the  Ferrier  school.  The  uniformity  of  cell  structure  in 
the  separate  layers  of  the  cortical  substance  is  contin- 
uous, and  nowhere  bounded  by  the  surface  fissures  and 
convolutions.  In  other  words,  all  the  convolutions  are 
similar  in  structure,  and  were  sections  of  each  cut  out 
from  without,  inwards,  and  submitted  to  the  closest 
analysis,  no  microscopist  could  tell  where  to  locate  each 
part.     All  are  as  uniform  as  would  be  sections  of  the 


cortical  nubstance  of  the  liver  or  kidney.  If  we  com- 
pare the  coiivolutional  striictureH  of  the  cerebrum  with 
that  of  the  cerebellum,  it  will  be  Heeii  that  they  are  con- 
structed on  the  same  plane.  (Richet.)  In  the  region 
where  the  distinctive  giant  cells  exist,  (i.  e.,  in  the  five 
layer  type  of  the  ascending  frontal  and  parietal  convo- 
lutions), all  the  cortical  regions  of  grey  matter  have  no 
distinctive  anatomical  characteristics  except  the  pres- 
ence of  c:innt  cells.  Charcot  suii:2rests  that  all  the  differ- 
ent  sized  cells  mav  be  of  the  same  kind  in  different 
degrees  of  development.  In  this  way  he  thinks  it  pos- 
sible that  even  motor  centers  may  change  their  centers. 
This  is  a  convenient  theory  to  account  for  the  fact  that 
such  an  attack  as  aphasia  often  passes  away,  although 
its  so-called  motor  center  remains  impaired. 

This  want  of  dividing  lines  on  the  external  surface  of 
the  brain  is,  on  physiological  grounds,  a  momentous  ob- 
jection to  distinct  centers  in  the  coi'tieal  substance.  Let 
us  now  consider  this  subject  from  another  point  of 
view.  Fritsch,  Ilitzig,  and  other  experimenters  agree 
that  in  no  appreciable  degree  do  mechanical  or  chemical 
agents  excite  motion  in  the  cerebral  substance.  Excite- 
ment by  galvanism  is  said  to  be  very  feeble,  and  very 
limited  in  either  the  cerebrum  or  cerebellum,  and  this 
want  of  response  is  seen  throughout.  It  is  evident  that 
in  this  way — powerful  as  the  agent  is — no  functional 
center  could  be  found  on  the  surface.  Herrman  shows 
that  even  after  the  grey  matter  is  destroyed  by  chemical 
cauteries,  a  very  feeble  cuiTent  of  galvanism  applied  to 
this  surface  produced  a  slight  movement,  and  signifi- 
cantly adds  that  in  cutting  away  slices  from  the  brain, 
the  effect  was  more  decided  in  proportion  as  the  central 
regions  were  approached.  (Richet.)  In  other  words, 
the  focus  of  nerve  energy  seemed  to  be  in  the  ganglia 
at  the  base  of  the  brain,  and  that  the  destruction  of  the 


cere})i'al  substance  did  not  produce  that  di.stur'baiice  of 
the  system  commensurate  with  the  loss  of  sul»stance, 
once  supposed  to  be  so  necessary  to  the  continuance  of 
physical  life  and  mental  action.  Kichet  says,  in  speak- 
iuG^  of  the  localization  theory  as  propoundcnl  by  Ferrier 
and  his  ardent  followers,  that "  absolute,  inflexible  local- 
ization of  the  motor  zones  is  impossible.  There  are 
zones  which  encroach  upon  each  other,  but  none  of 
these  zones  have  limits  of  determined,  rigorous  constancy. 
The  best  i)roof  of  this  is  the  difference  existini?  amonj? 

J.  i~  a 

authors."  If  this  means  anythin*;,,  it  is  that  although 
paralysis  and  abnormal  functions  of  the  brain  in  many 
instances  follow  the  destruction  of  certain  cortical  parts 
or  are  the  results  of  disease,  and  although  a  certain 
degree  of  uniformity  in  physical  results  follows,  yet  it  is 
equally  ti  ie  that  these  same  areas  may  be  destroyed 
without  any  such  manifestations  following.  Their  own 
experiments  are  taken  as  proof  of  this  fact.  These  cir- 
cumscribed areas  can  not  therefore  by  any  show  of 
reasoning  be  tlte  organs,  which  are  tlie  centers  of  dis- 
tinct functional  activity.  These  local  changes  may 
affect  the  co-ordinating  and  mental  powers,  but  the  cen- 
ters of  these  activities  must  be  sousrht  for  elsewhere. 
To  reconcile  these  undoubted  variations  in  results  and 
possibly  arrive  at  the  truth,  let  it  be  assumed  that  the 
basal  ganglia  are  the  centers  of  these  functions.  Let  it 
also  be  assumed  that  the  cerebrum  and  cerebellum  are 
not  directors  of  motion,  but  onlv  conservators  of  nerve 
energy,  both  receptive  and  functional.  Let  us  say  that 
these  ganglia  are  focal  centers  to  all  the  nerve  tracts  of 
the  system.,  Whatever  nerve  injury  may  do  in  other 
parts  of  the  nerve  mass  within  the  skull,  without  dan- 
gerous results,  it  is  evident  by  experiments  and  the 
results  of  disease  that  no  serious  impairment  can  take 
place  in  all  or  any  part  of  these  ganglia  without  dis- 


G 


aster;  lience  tlieir  Hiipreme  ini[)()i'taiicc*.  In  fuet,  tluH 
focua  of  influence  mii^lit  be  called  the  metropolis  of  life. 
Maudsley,  in  "The  Patholoc^y  of  Insanity,"  says:  "The 
disturbance  of  the  cortical  cells  is  in  reality  secondary ; 
it  is  a  reflex  functional  result  of  the  primary  morbid 
action  that  is  going  on  in  the  neighlK)rhood."  And 
again:  "Portions  of  the  hemispheres  may  be  cut  away 
without  the  patient  feeling  it,  though  he  is  fully  con- 
scious." Ferrier  locates  the  motor  center  of  the  oppo- 
site upper  limbs  in  the  upper  part  of  the  ascending 
frontal  convolution  ;  in  the  Jirst  frontal  convolution  the 
movements  of  the  head ;  in  the  second  or  center  convolu- 
tion the  motive  power  of  the  facial  movements ;  and  in 
the  third  convolution  the  center  of  the  movement  of  the 
tongue  and  lips  in  monkeys,  and  the  center  of  the 
faculty  of  articulate  speech  in  man.  This  is  often  called 
"  Broca's  Convolution."  In  the  s\(pevior  purietal  lol^e  is 
located  the  center  for  the  movements  of  the  lower  limbs. 
The  gyrus  angularis  is  said  to  possess  some  influence 
over  sight.  Dr.  Laffont,  in  a  paper  read  before  the 
Paris  Anatomical  Society  of  last  year,  states  "  that  the 
center  which  controls  the  circulation  of  the  abdominal 
viscera  is  in  the  floor  of  the  fourth  ventricle,  because 
local  irritation  of  this  part  produces  unusual  activity  in 
the  blood  movement  of  the  liver  and  intra-abdominal 
organs."  Other  investigators,  equally  credible,  say  that 
the  grey  substance  of  the  fourth  ventricle  is  the  motor 
center  of  respiration.  The  occipital  lobes  the  centers  of 
vision.  Aphasia,  or  the  loss  of  ideo-motor  coordination, 
is  circumscribed  by  some  to  disease  or  injury  of  the  pos- 
terior part  of  the  third  left  frontal  convolution.  In 
passing,  it  may  be  said,  that  Ferrier  still  farther  divides 
his  ftinctional  foci,  and  puts  "subjective  auditive  sensa- 
tion" in  the  first  temporal  convolution,  and  "  subjective 
olfactory  sensation  "  in  the  cornua  ammonis.      In  short, 


it  iiiJiy  ])0  said  tluit  in  cercbnil  locjiliziition,  tlie  eneoph- 
alon  (loos  not  represent  a  liomo'jjencous  organ,  an  unit, 
hut  ratlier  an  association,  or  a  confederation,  eonip'^ned 
of  a  certain  nundxr  of  diverse  organs.  To  each  of  these 
organs  belong  distinct  pliysiological  properties,  functions 
and  faculties.  (Charcot.)  It  is  vv(;ll  to  keep  these 
views  in  mind  and  see  if  they  are  corroborated  by  facts. 
It  is  to  be  remembered  that  there  is  no  direct  nervous 
communi(;ation  with  tlie  body  from  the  cerebrum  and 
cerebellum  except  through  the  basal  ganglia,  notwith- 
fitanding  statements  to  the  contrary.  Whatever  injury, 
disease  or  traumatic  lesion  may  inflict  on  these  upper 
nerve  masses  with  comjiarfttive  inij)unity,  analogous 
injury  from  the  same  causes  can  not  be  inflicted  on  the 
central  or  base  organs  without  dangerous  results.  In 
othei"  words,  these  are  the  true  motor  and  sensoiy  cen- 
ters of  the  system,  and  there  is  no  necessity  of  going 
beyond  them  to  ])rove  a  localisation  theory.  The  dis- 
tinction ])et',veen  these  oy  well  defined  boundaries,  and 
the  want  of  uniformity  in  structure,  point  strongly  to 
distinct  functions.  The  outshoots  of  the  spinal  cord  and 
the  numerous  nerve  ramificati<ms  not  only  to  the  organs 
of  special  sense,  but  also  to  the  locomotive  and  organic 
systems,  point  out  these  districts  as  being  the  peculiar 
focal  points  of  functional  and  psychical  life.  If  this 
theory  be  correct,  it  can  explain  all  the  phenomena 
manifested  by  experiments  made,  and  pathological  con- 
ditions found,  on  the  cortical  substance,  without  resort- 
ing to  the  chart  made  out  from  such  shifting,  incomplete 
and  changeable  boundaries  as  the  sulci  of  the  convolu- 
tions afford.  The  "  bumpologist "  conveniently  locates 
all  mental  centers  in  the  cortical  substance  nearest  to 
his  manipulations,  and  ignores  all  the  similar  surfaces 
at  the  base  and  between  the  hemispheres,  because  this 
.  terra  incognita  is  not  convenient  to  map  out.     He  can 


8 

not  reach  these  parts.  Therefore  they  must  be  useless 
appendages.  He  forgets  nature  has  no  lumber  room. 
In  somewhat  the  same  wav,  the  Ferrier  school  of  inves- 
tigators  find  certain  functional  di.^turbances  following 
the  abrasion,  excision,  or  galvinism  of  definite  cortical 
parts  with  a  considej'able  degree  of  uniformity.  Based 
on  these  manifestations  already,  with  considerable  con- 
fidence, it  is  said  nearly  all  the  functions  of  the  body 
are  located  on  the  exterior  pai't  of  the  nerve  mass,  which 
is  within  reach  of  experiment,  and  somewhat  hasty  con- 
clusions are  drawn  from  the  results.  All  the  rest  of 
the  brain  mass  which  has  a  substance  exactly  similar  in 
structure  to  the  external  grey  matter,  is  practically  ig- 
nored, in  spite  of  its  paramount  importance,  and  wliicb 
is  also  evident  from  the  complexity  of  the  structure, 
and  from  the  fatal  results  whicli  flow  from  injury  to 
these  central  parts.  It  seems  to  be  overlooked  that  any 
injury  to  the  cortical  substance  must  necessarily  aflfect 
tho  lower  ganglia  to  which  it  lies  in  juxta])osition,  and 
to  which  it  stands  so  nearly  related.  The  periphery  of 
the  brain  doubtless  has  much  to  do  in  stimulatins:  to, 
action  these  centers.  In  the  latter  are  found  the  dis- 
tinctive seats  of  functional  activity,  and  in  the  superim-i 
posed  mass  the  residuary  power  to  impel  but  not  to 
direct — to  give  additional  vitality,  but  not  to  indicate 
the  mode  and  direction  this  force  is  to  take.  This  dis- 
criminative power  is  left  to  be  performed  by  these  cen- 
tral glands,  which  are  safely  situated  in  the  center  of 
these  sympathetic  and  active  auxiliaries.  Not  only  is 
this  true  in  respect  to  function,  but  it  is  equally  true  as 
respects  sensation.  Sensation  and  function  have  a  com- 
munity of  interests,  and  are  focalized  together.  Dr.. 
Symonds,  in  the  Gulstonian  lectures,  says :  "  Pain  does 
not  seem  to  be  in  the  nervous  matter,  whether  vesicular 
or  tubular,  of  the  cerebral  hemispheres,  or  of  the  cer- 


riiliililBi 


I 


9 

ebelluin.     No  evidence  of  feeling  lias  been  obtained  by 
vivisectoj-s  till  they  approar*hed  the  sensory  ganglia — 
the  thalami  optica  and  corpora  quadrigemina.      But 
these  are  the  centers  of  sensation  to  all  parts  of  the 
body  as  well  as  to  the  head."     It  is  satisfactory  to  see 
that  recent  investigators  are  paying  more  attention  to 
the  central  organs.     Their  researches  go  to  show  that 
very  important  functions  are  likely  to  be  found  having 
their  excito-motor  centers  in  the  internal  parts  of  the 
brain.     These  experiments — as  far  as  they  go— 7point  to 
the  probabilities  of  ray  theory  of  localization,     liichet, 
in  speaking  of  cerebral  incitation  by  means  of  electricity, 
is  forced  to  sa}^  in  explanation  of  certain  phenomena: 
"  Known  facts  demonstrate  that  excitation  of  the  con- 
volutions which  surround  the  sigmoid  gyrus  act  with 
extreme  energy  upon  the  ganglionic  centers  of  the  brain, 
(opto- striated  bodies).      It  is  possible  that  such  excita- 
tion culminated  in  the  cerebral  centers,  and  that  these 
centers,   thus   surcharged,    discharge   to   the   muscles." 
Charcot  says,  in  speaking  of  the  lenticular  nucleus  of 
the  corpus  striattnn^  "these  grey  nuclei  are  possibly  so 
many   centers   endowed  with  distinct  properties   and 
functions."     This  is  a  germ  idea  of  the  theory  I  pro- 
pounded several  years   ago,  in  the  following  words: 
"  Large  portions  of  the  cerebrum  and  cerebellum  may 
be  taken  away  from  the  living  body  without  immediate 
danger  of  death,  but  the  organs  in  the  base  of  the  brain, 
from  which  spring  the  numerous  nerves  so  essential  to 
life,  can  not   be  touched  in  vivisection  or  by  disease 
Avith  impunity.     From  this  central  region  nerve  influence 
radiates  to  every  part  of  the  body,  making  its  connec- 
tions with  the  depositories  of  nerve  power  in  the  spinal 
cord,  and  with  the  ganglia  of  the  sympathetic  system." 
(  Vide  "  An  Animated  Molecule,"  p.  28).     The  experi- 
ments of  Lussana  and  Lemoigne  go  to  show  that  the 


BBS&BSSaiB^^BBBBH 


10 


foci  of  various  special  movements  were  found  about  the 
base  of  the  encephalon,  pons,  medulla  oblongata  and 
other  parts.  The  considerable  amount  of  lesion  often 
discovered  at  the  floor  of  the  fourth  ventricle  in 
general  paralysis,  and  the  degeneration  of  cerebral  and 
spinal  nerves,  warn  us  against  too  ready  an  indictment 
of  motor  centers  in  the  cerebral  cortex,  as  answerable 
for  the  frequent  and  characteristic  motor  impairment; 
that  of  the  lips,  tongue,  face  and  articulary  organs  gener- 
ally. (Mickle,  General  Paralysis,  ed.  1880).  If  Charcot 
had  added  to  his  hypotheses  the  probability  that  the 
base  and  central  ganglia  were  the  true  and  only  motor 
centers,  a  solution  of  the  difficulties  which  surround  the 
Ferrier  system  could  be  arrived  at  without  ignoring  the 
doctrines  of  localization.  Let  the  area  be  circumscribed 
to  really  the  most  vital  parts  of  the  brain,  then  could 
all  the  phenomena  be  explained.  It  would  then  become 
more  evident  why  traumatic  injury  and  destruction  from 
pathological  processes  on  the  surface  are  not  always 
followed  by  functional  and  mental  unsoundness.  If  this 
explanation  be  accepted  it  will  be  seen  that  the  surfaces 
and  upper  portions  of  these  nervous  masses  thus  become 
adjuncts  to  vital  organs  in. the  center  and  base  of  the 
brain.  The  former,  in  their  analogy  of  Scructures  and 
juxtaposition,  give  power  but  do  not  impart  function ; 
they  are  auxiliaries  but  not  necessities  to  the  ganglionic 
centers;  they  intensify  energy  but  do  not  direct ;  they 
are — as  it  were — additional  cells  to  the  battery,  but  are 
not  its  controlling  agency.  I  repeat  this  view  in 
another  form  to  avoid  ambiguity  and  misconstruction. 
It  is  worthy  of  remark  in  this  connection,  as  it  is  a  mat- 
ter of  e-^iperiment,  that  such  a  large  area  as  the  Rolandic 
zone  can  be  destroyed,  and  yet  leave  the  intelligence 
unimpaired.  A  considerable  portion  of  the  frontal  or 
€ven  of  the  occipital  lobes  can  be  removed  without  any 


m 


^' 


11 

apiiftreiit  alteration  of  tlie  intellectual  powers.  The 
coiTeapcnding  lobes  of  either  the  frontal,  occipital,  or 
parietal  regions  have  been  destroyed  without  affecting 
the  conscious  being,  or  those  functions  said  to  hkve  their 
seat  of  power  in  these  parts.  It  is  evident,  then,  that 
these  are  not  the  s^.o  habitations  of  mind  or  certain 
physical  operations.  The  reciprocity  between  mind  and 
body  is  strikingly  seen  in  aphasia.  There  can  be  no 
aphasia  without  more  or  less  impairment  of  the  mem- 
ory, judgment  and  imagination,  yet  this  functional  and 
mental  disorder  can  exist  either  with  or  without  injury 
to  the  third  frontal  convolution.  What  basis,  then,  is 
there  to  suppose  it  so  necessary  to  certain  physical 
operations?  If  it  could  be  shown  that  sight,  hearing, 
tasting,  often  were  accomplished  when  the  optic  and 
auditory  and  gustatory  nerves  and  the  region  of  their 
insertion  were  destroyed,  then  it  would  be  plain  that 
these  were  not  the  only  tracts  of  nerve  influence  for 
these  centers  of  special  sense  to  reside  in,  nor  the 
avenues  of  each  peculiar  manifestations  of  sensation. 
In  the  same  way,  if  we  can  have  aphasia,  paralysis  of 
the  legs,  arms  and  face  with  these  so-called  centers  of 
nerve  force  unimpaired,  or  if  impaired  without  these 
results,  then  it  is  beyond  controversy  that  this  doctrine 
of  the  cortical  localization  of  specific  functional  energy 
is  not  proven.  What  may  be  in  store  in  the  future  for 
these  earnest  and  honest  workers  is  only  matter  of  con- 
jecture. Richet  pertinently  says,  (page  115)  :  "If  the 
crucial  furrow  is  really  the  motor  center  of  the  legs,  then 
by  removing  both  right  and  left  convolutions  the  legs 
should  become  paralyzed ;  if  not,  then  it  is  not  a  true 
motor  center.  It  would  then  be  necessary  to  admit 
that  there  are  several  organs  for  one  function,  several 
motor  centers  for  one  limb,  which  is  contrary  to  prob- 
ability and  to  fact."     He  suggests  as  a  way  out  of  the 


\ 


12 


difficulty  that  aa  the  spinal  cord  conduction,  (according^ 
to  Vulpian),  is  carried  on  equally  by  all  parts  of  the 
grey  matter,  it  is  possible  that  the  same  indifference 
holds  for  the  brain,  though  less  in  degree.  In  other 
words,  there  are  hahitiial  roads^  hut  no  coirqyulsorfj  ones. 
This  view  would  be — if  true — a  death  blow  to  the  or- 
ganic local  theory,  as  applied  to  the  cortex.  This  theory 
would  not  meet  Ferrier's  definition  of  localization,  which 
is  said  by  him  to  be  "a  complex  arrangement  of  indi- 
vidually differentiated  centers,  which  in  associated 
action,  regulate  the  various  muscular  adjustments  nec- 
essary to  maintain  equilibrium    >f  the  body." 

It  will  be  seen  that  so  for  the  l  atest  interest  cc^+ers 
round  the  third  left  frontal  convolution  on  accou.ii  of 
the  stress  laid  on  the  fact  that  aphasia  is  so  often  found 
as  a  result  of  its  injured  or  diseased  condition  If  it 
can  be  proved  that  this  imperfection  of  speech  is  always 
conjoined  with  an  impaired  condition  of  this  locality 
and  never  otherivise,  then  is  the  battle  won  for  localiza- 
tion of  functional  power  in  the  cortical  substance,  for  it 
would  be  fair  to  infer  that  other  centers  for  other  func- 
tions would  be  found  in  similar  parts  of  the  same  field 
of  investigation.  Unfortunately  for  this  doctrine,  the 
exceptions  to  these  results  are  too  many  to  be  ignored, 
and  these  sl  jw^  that  this  spot  is  not  the  center  of  speech, 
nor  its  injury  the  sole  cause  of  aphasia.  I*"  has  been 
found  in  numbers  of  examples  that  aphasia  is  found  with 
this  convolution  intact.  Not  only  this,  but  it  is  known 
that  defects  in  speech  in  its  different  forms  of  language 
such  as  writing,  reading,  sinewing,  drawing  and  imitation 
— in  fact  aphasia  in  all  its  Ibrms  follow  lesion  in  the 
island  of  Reil.  {London  Lancet^  Amer.  Ed.,  July,  1880, 
p.  34.)  Aphasia  is  known  to  exist  as  the  result  of  dis- 
ease in  the  right  hemisphere,  and  that  not  in  the  corre- 
sponding third  frontal  of  the  hemisphere.     It  can  not 


18 

be  supposed  this  reputed  motive  brain  tissue  which  ex- 
cites the  functions  of  speech  may  be  destroyed  and  yet 
the  peculiar  energy  which  animates  it  can  remain  un- 
abated after  its  obliteration  has  taken  place,  unless  it  is 
claimed  that  the  corresponding  convolution  on  the  right, 
in  a  vicarious  way,  does  the  work  of  its  fellow.  If  such 
were  the  case,  then  the  third  left  frontal  convolution 
could  clain;  no  preeminence,  as  the  sole  seat  of  the  fac- 
ulty of  articulate  language.  To  get  over  this  difficulty 
this  school  of  thinkers  introduce  what  is  called  the 
theory  of  8upple7nentation.  They  say  some  other  part 
of  the  cortical  substance  comes  to  the  rescue  when  any 
center  of  function  is  destroyed.  This  neighborly  as- 
sumption of  peculiar  and  distinct  labor  is  not  found  in 
any  other  part  of  the  system,  however  willing  the  organs 
may  be  to  give  a  helping  hand  to  one  another.  We 
are  told  it  may  be  the  corresponding  part  or  some  other 
cortical  area.  This  is  virtually  a  giving  up  of  the  doc- 
trine of  these  so-called  "  true  motor  centers."  Here  let 
me  say,  in  passing,  that  fallacy  in  vivisection  often  arises 
in  forgetting  that  experiments  on  the  brains  of  inferior 
beings  by  the  destruction  of  parts,  do  not  always  pro- 
duce analogous  effects  on  man  when  corresponding  parts 
are  injured.  We  may  remove  the  whole  of  a  cerebral 
hemisphere  of  a  pigeon  or  rabbit,  with  the  only  func- 
tional result  of  a  slight  impairment  in  flying  or  jumping. 
No  hemip^  ^ia  will  follow  such  as  is  the  case  with  like 
injury  to  the  dog  or  monkey.  Man  is  much  more  sensi- 
tive to  such  lesions  only  in  certain  parts.  In  fact,  the 
whole  brain  may  be  removei^  in  many  creatures  without 
affecting  their  locomotion.  vV^e  know  that  in  man,  dis- 
ease, such  as  sclerosis  and  softening,  may  cut  off  the 
spinal  cord  from  cerebral  influence,  yet  functional  activity 
in  the  parts  supplied  by  it  still  goes  on  with  unabated 
vigor.     In  the  same  way,  we  find  that  if  the  base  and 


14 


central  organs  remain  unimpaired,  no  marked  symptoms 
arise  except  by  sympathetic  connections  with  adjacent 
parts.  This  shows  the  fallacy  of  reasoning  by  analogy 
between  man  and  animals  based  on  experiments.  There 
are  common  results  and  also  great  differences. 

It  is  now  important  to  say  a  few  words  about  the  cir- 
culation of  blood  in  the  brain,  to  show  how  much  more 
plentifully  the  center  and  base  are  supplied  with  blood 
than  are  the  superioi*  parts  of  the  cerebrum  and  cerebel- 
lum. It  is  not  to  he  forgotten  that  where  the  largest 
supply  of  blood  is  needed  for  nutrition^  there  is  found  the 
greatest  functional  activity.  We  are  all  well  acquainted 
with  the  wonderful  distribution  and  anastaraoses  of  the 
blood  in  the  base  of  the  brain,  both  in  the  circle  of  Willis 
and  in  the  cerebral  arteries  springing  from  this  polygon 
of  vessels.  We  are  also  aware  of  the  fact  that  two  sets 
of  branches  shoot  from  these  main  trunks  in  almost  par- 
allel lines.  The  one  class  goes  into  the  medullary  and 
cortical  substance  in  an  outward  direction  from  those 
central  reservoirs,  but  does  not  reach  the  surface ;  another 
class  runs  to  the  periphery  and.  forms  the  pia  maiery 
from  which  branch  inwards  numerous  arterioles  to  sup- 
ply the  cortical  and  medullary  parts  not  reached  by  the 
vessels  springing  from  the  center.  These  two  sources 
of  supply  are  not  only  distinct  as  between  each  of  their 
own  vessels,  but  also  unconnected  to  a  great  extent 
vrith  one  another.  The  anastamosis  between  these  two 
sets  of  vessels  is  very  slight  indeed.  The  streamlets  in 
each  can  be  dried  up  or  seriously  interrupted  in  many 
ways  without  disturbing  the  neighboring  vessels  to  any 
appreciable  degree.  This  accounts  for  so  many  circum- 
scribed lesions  in  these  parts,  and  for  the  little  effect 
they  produce  in  the  adjacent  tissues  and  circulation.  I 
am  inclined  to  think  that  on  account  of  this  localization 
of  circulation  and  consequently  a  tendency  to  restiicted 


IS 


mmm 


I 


15 

areas  of  disease,  a  good  many  fallacies  of  reasoning  have 
obtained  currency  in  respect  to  centers  of  function. 
Heuhner  cites  pathological  cases,  which  indicate  that 
obliteration  of  one  of  the  large  vessels  of  the  cortical  sys- 
tem, or  any  of  its  branches,  have  during  life  given  no 
pronounced  symptom.     (Charcot). 

Let  us  now  turn  to  the  arterial  cii'culation   in  the 
grey  central  garujUa,     This  section  includes  the  thalami 
opticl^  the  corpora  ntriata^  and  their  appendages.     It 
needs  only  a  moment's  reflection  of  our  anatomy  to  real- 
ize that  the  central  ganglia  are  largely  supplied  from 
the  Sylvian  artery,  as  well  as  from  the  nutrient  vessels, 
which  spring  in  large  numbers  from  all  the  cerebral 
arteries  and  from  the  basilar  at  its  bifurcation.     The 
sum  total  of  all  these,  show  a  much  greater  capacity  for 
blood  supply  per  square  inch,  than  in  any  other  part  of 
the  brain.     Such  being  the  case,  we  know  this  aug- 
mented normal  supply  means  proportionally  increased 
activity.     Hence  it  follows  as  a  matter  of  fact  that  any 
abnonnal  increase  or  decrease  of  blood  means  a  greater 
or  less  physical  or  mental  perturbation.     Congestion,  as 
well  as  anaemia,  is  followed  by  the  same  results,  that  is, 
more   or  less  suspended  sensibility  and  retarded  vol- 
untary action.     Where  the  blood  supply  is  found  to  be 
naturally  the  most  copious,  there  is  greater  susceptibil- 
ity of  this  kind,  and  as  ...  corollary  it  may  be  added, 
there  is  functional  activity  in  proportion  to  th    normal 
blood  supply.     The  difference  in  this  respect  between 
the  cortical  substance  and    the  central  parts  is  most 
marked.     This  points  to  the  former  as  being  only  sub- 
sidiary to  the  latter,  taking  the  circulation  as  a  physio- 
logical basis  to  judge  from  in  this  respect.     Although 
the  central  and  basal  ganglia  are  much  less  in  bulk 
than  is  the  cortical  substance,  yet  about  one-half  of  the 
blood  which  enters  the  encephalon  is  distributed  to  the 


•: 


.10. 

former.  It  would  be  interesting  to  know  if  this  un- 
equal supply  has  anything  to  do  with  the  pathological 
fact  that  in  hemiplegia  from  coi'tical  disease  we  find  it 
"limited,  transient,  and  variable,"  (Charcot),  but  in 
paralysis  of  the  body  from  central  disease  it  is  perma- 
nent, general,  and  uniform.  It  is  a  pathological  fact 
that  paralysis,  general  or  partial,  can  be  produced  by 
any  lyart  of  the  brain  being  affected  with  inflammation, 
embolus,  or  tumor,  showing  that  loss  of  function  is  not 
consequent  on  degeneration  or  destruction  of  some  lo- 
calized spot.  That  part  of  the  brain  which  demands 
the  greatest  amount  of  blood  in  the  performance  of  its 
work  must  necessarily  have  the  gi'eatest  activity.  Let 
me  then  repeat,  in  another  form,  that  a  very  superficial 
knowledge  of  the  brain  circulation  indicates  how  direct 
and  ample  is  the  blood  supply  to  the  base  and  central 
ganglia  in  comparison  with  the  cortical  supply.  This 
is  especially  true  of  the  arteries  which  run  to  the  cor- 
pus striatmn  and  thalamus  opticus.  The  cortical  sub- 
stance is  nourished  in  a  roundabout  way  through  the 
pia  matei\  but  the  central  system  is  reached  directly 
through  the  large  central  vessels  springing  from  the 
circle  of  Willis,  which  furnishes  a  perfect  fountain  of 
blood  supply  near  at  hand.  So  distinct  and  important 
is  the  circulation  in  this  grand  center,  that  when  oblit- 
eration of  the  Sylvian  artery  takes  place,  all  the  gan- 
glionic centers  are  affected,  and  cerebral  hemiplegia, 
accompanied  by  hemiansesthesia  is  the  result.  This 
physiological  fact  alone,  shows  the  greater  importance 
these  ganglia  hold — it  seems  to  me — as  functional  cen- 
ters in  comparison  to  the  cortex  or  even  the  entire  hem- 
ispheres. Since  writing  the  above  I  nnd  that  Professor 
M.  Schiff,  of  Florence,  has  caught  the  same  idea,  when 
lie  says  in  his  monograph  on  "Motor  Centers"  that 
"  human  and  comparative  pathology  have  stated  with 


. 


ir 

certainty  that  tlie  motor  centers  do  not  extend  above 
the  base  of  the  brain."  KiiIosh  my  attempt  to  V)e  brief 
has  led  to  ambiouity,  it  will  be  seen  that  amon<^  the 
probabilities  of  tliis  o))scure  subject  the  ex[)lanations  I 
have  given  in  defense  of  the  theory  enunciated  are 
based  on — 

I.  The  radical  difference  found  in  the  circulation  of 
the  l)lo()(l,  both  as  to  mode  of  distril>ution  and  quantity, 
leading  to  the  reasonable  inference  of  greater  functional 
activity  existing  in  the  center  than  in  the  circumference 
of  the  brain.  The  more  life-action  in  any  part  the  more 
is  blood  snpply  needed. 

II.  The  want  of  uniformity  in  functical  results, 
when  definite  and  alike  portions  of  the  cortical  sub- 
stance are  stimulated,  impaired  or  destroyed,  hence  this 
can  not  be  the  seat  of  so-called  motor  centers. 

III.  It  would  be  consonant  with  pathological  and 
experimental  facts  to  locate  these  motor  and  psychical 
centers  in  the  base  and  center  ganglia,  yet  in  sympa- 
thetic relations,  being  influenced  but  not  absolutely 
controlled  by  the  cortical  substance. 

IV.  The  want  of  distinctive  physiological  features 
in  the  different  convolutions. 

I  will  now  give  a  few  examples  of  brain  injury, 
illustrative  of  these  views.  The  first  are  culled  from 
the  surgical  records  of  the  War  of  the  Rebellion. 

Private  Hughes,  was  wounded  at  the  battle  of  Antietam.  The 
Hospital  Reports  say  that  the  injury  was  a  perforation  of  the  skull 
by  a  single  conical  musket  ball  entering  near  the  inner  posterior 
angle  of  the  right  parietal  and  emerging  at  a  higher  point  of  the 
left  parietal,  making,  after  traversing  a  portion  of  the  brain,  a 
large  exit  wound.  At  the  time  of  this  extensive  injury  he  dragged 
himself  from  the  field,  but  he  did  not  lose  his  consciousness.  Eight 
days  after  the  injury  it  is  reported  the  general  condition  of  the 
patient  was  good ;  suppuration  had  commenced ;  no  febrile  action 
existed,  the  pulse  was  regular;  sleep  not   materially  disturbed, 


18 


mind  clear,  and  inanifeKtod  no  hIj^iis  of  conipression  of  the  hruin,  or 
influmniiition  of  its  membranes.  When  the  swelling  of  the  Hcalp 
subsided,  a  prominenee  of  brain  substance  was  lound,  one  inch  in 
height  and  three  inches  in  length,  in  which  the  pulsation  of  the 
arteries  could  be  distinctly  observed  ;  Kpii^dai  of  bone  came  away 
from  time  to  time,  and  the  tumor  Hul)sided  within  the  cranium. 
On  December  2()th,  1870,  or  over  eight  years  after  the  injury,  ho 
was  examined  by  two  medical  nu'ii.  Previous  to  this  time  he  had 
worked  in  an  iron  foundry.  His  memory  remained  quite  good. 
lie  had  no  paralysis,  and  it  is  reported  by  I)rs.  Keen  and  Thom- 
son that  it  is  remarkable  to  observe  the  ahnost  entire  restoration 
of  his  mental  faculties,  especially  in  view  of  the  probable  deep 
lesion  of  the  bvain,  both  by  the  primary  injury  and  the  subsequent 
fungus  cerebri. 

It  will  be  seen  that  in  this  case  there  was  no  func- 
tional disorder,  except  that  for  a  sliort  time  at  first  "  the 
"brain  functions  seem  clouded."  This  might  be  expected 
for  a  time. 

Private  Sheridan,  was  shot  through  the  left  temporal  region. 
The  missile  lodged  in  the  brain,  and  was  never  extracted.  At  the 
close  of  the  war  he  was  discharged  recovered,  and  received  no 
pension.     No  functional  disturbance  at  any  time. 

Corporal  Farrium,  woiMided  by  a  round  ball  entering  the  cra- 
nium and  brain  matter.  He  recovered  and  was  put  in  the  Veteran 
Reserve  Corps.  He  was  not  jiensioned.  He  was  none  the  worse 
for  the  wound  at  any  time. 

Private  Dillon,  was  wounded  by  a  bullet  which  entered  the  cra- 
nium very  near  the  superior  angle  of  the  occipital  bone,  and  had 
passed  anteriorly  into  the  substance  of  the  brain.  He  lay  on  the 
field  of  battle  two  days  without  any  attention.  After  being  a  year 
invalided  he  returned  to  active  sCi  vice,  perfectly  well  physically, 
but  with  the  intellect  slightly  impaired.  Afterwards  he  was  mus- 
tered out  the  service,  perfectly  well,  and  was  not  pensioned. 
The  ball  was  not  extracted.  After  the  first  shock  there  was  no 
functional  disturbance. 

Private  Bemis,  wounded  by  a  ball  entering  a  little  outside  the 
left  protuberance,  and  passing  bacl.wards  and  outwards.  It  re- 
moved a  piece  of  the  squamous  portion  of  the  temporal  bone,  with 


*% 


i$ 


: 


ii 


19 

l)rain  substanoo  aiul  mombranoH.  When  the  patient  entered  tho 
Hospital,  brain  matter  was  oozinjr  from  the  wound.  At  first  rcs- 
j)iration  was  slow  ;  |)iilse  40  ;  the  rij^lit  side  was  paralyzed  and 
there  was  total  insensibility.  Three  days  alter  the  injury  tlio  bul- 
let was  extraeted  from  the  substanee  of  the  left  hemisphere.  It 
was  a  conoidal  ball,  and  badly  shattered,  lie  then  rapidly  recov- 
ered, and  the  report  says  that  in  fotir  months  and  a  half  afterwards 
"  the  nu'iital  and  sensory  faculties  were  >inim|)aired."  On  Octo- 
ber 3()th,  1870,  he  wrote:  "I  am  still  in  the  land  of  the  livin<^. 
My  health  is  f^ood,  considerin^jj  what  1  passed  through.  My  head 
aches  some  oi  the  time.  1  am  married  and  have  one  child.  My 
memory  is  aile(rted,  and  I  can  not  hear  as  well  as  I  could  before  I 
was  wounded." 

These  were  the  only  resnlts  of  this  extensive  lacera- 
tion of  ])rain  matter.  The  wlight  functional  disturbance 
did  not  correspond  with  the  doctrine  of  cortical  func- 
tional centers. 

Sergeant  Rotherhara,  wounded  at  Gettysburg  by  a  musket  ball, 
which  penetrated  the  skull  near  the  right  frontal  eminence,  passed 
directly  inwards  and  lodged  somewhere  on  the  membranes  or  in 
the  brain  substance.  The  opening  through  the  bone  was  similar 
to  that  made  by  a  trephine,  and  the  track  of  the  ball  could  be  fol- 
lowed on  the  dura  mater  with  a  probe  for  a  considerable  distance, 
as  that  membrane  was  detached  from  its  natural  connections  with 
the  skull.  The  ball  was  not  extracted.  There  was  no  perceptible 
loss  of  power,  motion  or  sensation  on  either  side  of  the  body. 
There  was  no  arterial  excitement.  His  recovery  was  rapid,  and 
five  weeks  after  the  injury  he  was  furloughed  for  fifteen  days,  at 
the  expiration  of  which  time  he  returned  to  duty,  having  sutfered 
no  inconvenience  from  the  journey.  After  this  several  bones  ex- 
foliated, but  his  mind  was  not  impaired  to  any  perceptible  degree. 
For  some  time  after  the  wound  wat^  received  he  was  assigned  light 
duty  in  the  Veteran  Reserve  Corps  Hospital. 

Lieutenant  Brown,  at  the  battle  of  Wilson  Creek,  received  a 
penetrating  gunshot  wound  of  the  cranium  and  brain.  The  ball 
was  not  removed  for  seven  years  after  the  injury,  but  in  a  few 
days  after  being  wounded  he  was  ht  for  duty.  In  January,  1871, 
this  ofliicer  was  on  duty  as  Captain  in  the  13th  Infantry. 

Private  Stallman,  wounded  at  Winchester  by  a  musket  ball, 
which  entered  at  the  right  temple  and  emerged  at  the  opposite 


20 


T' 


:t    I 


i 


i:  1   I 

i'  ■   ! 


side  of  the  lioiid.  In  spite  of  tliis  Rcrious  lesion  of  bruin,  in  ji  few 
months  he  was  put  on  liglit  duty.  He  had  no  strahismns,  and  wo 
are  tohl  that  nllhonj^h  his  nuntal  faeidties  were  sh)W  and  uncer- 
tain, and  Ids  memory  impaired,  he  had  no  mental  halluciiuitionA 
nor  mental  aberrations.  The  year  following  the  injury  he  was 
pensioned.    No  functional  impairment  except  the  above-mentioned. 

Private  Haggart,  was  wounded  by  a  eonoidal  musket  ball,  which 
struck  the  left  side  of  the  head,  and  passing  through  carried  away 
a  large  part  of  the  left  half  of  the  occipital  l)one.  At  first  he  be- 
came insensible  and  lost  more  than  an  ounce  of  cerebrum, 
leaving  bare  the  meningeal  arlery.  Seven  motiths  afterwards  ho 
was  discharged  irom  the  Hospital.  At  that  time  both  eyes  were 
dilated,  causing  dimness  of  vision,  but  his  intellect  was  good,  and 
he  could  read  very  coarse  print.  He  diod  four  years  afterwards, 
but  it  is  not  recorded  what  was  the  cause  of  death.  This  extensive 
lesion  otdy  produced  these  slight  results. 

Sergeant  Woodman,  was  wounded  by  a  gunshot  missile,  which 
entered  above  the  left  frontal  eminence  and  emerged  at  a  point 
one  inch  behind  the  upjier  margin  of  the  right  ear.  He  was  un- 
conscious for  several  hours.  At  the  wound  of  exit  eight  small 
bones  aflerwards  discharged.  He  was  alive  three  years  afterwards, 
and  it  was  reported  that  the  organs  of  special  sense  and  the  intel- 
lect were  unimpaired. 

Private  Plumly,  was  wounded  by  a  eonoidal  musket  ball,  which 
entered  at  the  inner  angle  of  the  left  eye  and  after  passing  through 
the  brain  substance  it  emerged  behind  the  left  ear.  On  March  7th, 
1867,  nearly  three  years  after  the  wound  was  inflicted,  he  was  in 
good  health  and  a  pensioner.  The  only  physical  results  were  ob- 
Bcuration  of  the  vision  of  the  left  eve  for  a  short  time,  the  dis- 
charge  of  pus  irom  the  orifice  of  entrance  of  the  ball  and  through 
the  right  nostril  and  upper  part  of  the  posterior  nasal  cavity  into 
the  mouth. 

Private  Sechler,  was  wounded  by  a  eonoidal  ball,  which  struck 
the  OS  frontis  over  the  right  eye  and  passed  into  the  brain,  He 
not  only  lived,  but  returned  to  duty  six  months  afterv»ards,  and 
was  at  the  close  of  the  war  mustered  out,  so  well  that  he  did  not 
even  receive  a  pension.  The  ball  was  not  extracted.  No  func- 
tional results. 

Private  Samuel  D.  Solomon,  was  wounded  at  Bull  Run,  August 
27th,  1862,  by  a  carbine  bail,  which  struck  at  a  point  two  inches 


. 


21 


lu'liiiid  Iho  tip  c>i  tlic  Idt  v.w.  Tlu'  inissilo  cntt'rod  tho  bniin  to 
the  cxU  t  of  two  inches,  and  was  not  cxtniotiMl.  VVIion  Htnick  ho 
fell  to  t  '  ground,  bnt  retained  his  conseionsneHs.  Ilealtliy  Hup- 
pnration  followecl,  and  a  IVaj^inent  of  bone  wan  discliai'<j;ed  from  tho 
■woinid.  He  HnlVered  lieatlache,  and  also  from  acute  (hirtinj^  pains 
across  the  base  of  the  brain,  from  the  rijjjht  tenjplo  to  the  scar  of 
the  wound.  No  paralysis  existed,  an<l  the  functions  (  ♦"  the  body 
were  generally  well  performed.  He  afterwards  served  in  a  Wash- 
ington Hospital  in  the  capacity  of  njirse,  and  was  discharged  from 
the  Bervice  in  tho  8ubse<pient  year,  with  no  record  of  mental 
unsoundness  or  functional  disability. 

Corporal  Wood,  wounded  at  the  battle  of  Winchester  by  a 
conoidal  ball,  which  fractured  the  occipital  bone  and  entered  the 
brain.  This  was  Se[)tember  19th,  1804.  Ho  was  examined  by  a 
Confederate  Hoard  on  INIarch  24th,  1805,  whose  members  recom- 
mended that  he  might  be  emi)loyed  at  some  post  where  the  duties 
were  not  laborious,  showin^r  that  his  mental  faculties  could  not 
have  been  impaired  to  an  appreciable  degree.  No  functional  re- 
sults were  seen. 

Private  Sheridan,  was  wounded  at  tho  siege  of  Vicksburg  by  a 
canister  shot.  The  missile  entered  the  left  parietal  bone,  imme- 
diately posterior  to  the  coronal,  and  three  inches  from  tho  sagittal 
suture,  passed  horizontally  inward,  a  distance  of  two  and  a  half 
inches,  and  lodged.  The  ball  could  not  be  extracted.  Ho  suf- 
fered but  little  inconvenience.  The  wound  suppurated  freely, 
sometimes  bled,  and  small  fragments  of  bono  escaped.  Six  months 
after  ho  was  placed  to  work  on  the  lovoe,  and  experienced  no 
trouble  except  on  the  approach  of  a  storm,  when  he  had  a  dull  pain 
and  sensation  of  weight.  In  eight  months  after  the  wound  was 
received  he  returned  to  duty. 

Lieutenant  Lilycrantz,  wounded  at  Fort  Pulaski.  The  ball  per- 
forated the  OS  frontis  over  the  right  superciliary  ridge.  When 
first  seen  after  the  injury  he  was  vomiting  freely,  and  about  a  fluid 
ounce  of  brain  matter  had  exuded  from  the  wound.  A  probe,  five 
inches  long,  glided  easily,  by  its  own  weight,  its  full  length,  di- 
rectly backwards  through  the  wound,  without  coming  in  contact 
with  the  ball.  For  ten  days  the  patient  showed  a  tendency  to 
sleep,  but  was  easily  aroused  and  would  converse  freely,  constantly 
wandering,  however,  from  the  topic  of  conversation.  He  could,  at 
this  time,  neither  taste  nor  smell,  and  his  hearing  and  sight  wero 


22 


'  !,■    !   I! 


much  impaired.  He  recovered  his  mental  faculties  to  such  an  ex- 
tent as  to  be  employed  in  government  service  at  Washington,  and 
died  five  years  afterwards.  During  this  time  he  articulated  dis- 
tinctly, had  no  paralysis,  but  had  occasionally  slight  attacks  of  ep- 
ilepsy, but  they  were  becoming  slighter  as  time  wore  on. 

I  have  culled  these  cafes  out  of  559  persons  who  re- 
ceived penetratiuo^  or  perforating  fractures  of  the  skull. 
These  559  were  selected  out  of  4,350  cases  of  gunshot 
wounds  of  the  cranium  and  its  contents.  Of  that  large 
number,  many  were  afflicted  with  functional  and  mental 
disturbance,  but  in  no  two  cases  of  similarly  injured, 
were  there  like  results. 

Dr.  Van  Peyma  gives  a  recoi'd  of  a  singular  case  in 
the  Buffalo  Medical  and  Surgical  Journal^  December, 
1873. 

A  man  aged  50  was  found  comatose,  and  brought  to  the  Buffalo 
General  Hospital.  He  subsequently  was  sufficiently  roused  to  give 
his  name  and  age.  He  died  six  days  after  admission.  On  2^ost 
mortem  examination  the  meninges  on  the  right  side  were  found 
considerably  congested.  On  removing  the  brain  a  collection  of 
pus  was  found  at  itc  baso,  extending  from  the  medulla  oblongata 
forwards.  The  lateral  ventricles  were  also  found  filled  with  a  pur- 
ulent collection.  At  this  moment,  as  the  incisions  were  being  ex- 
tended, something  was  heard  to  fall  on  the  tray  on  which  the  brain 
was  lying.  To  our  utter  amazement  this  was  found  to  be  a  bullet. 
The  ball,  which  was  of  small  size  and  considerably  flattened,  had 
been  liberated  by  tha  knife.  The  conviction  was  forced  upon  us, 
(says  the  surgeon,)  that  the  external  opening  through  which  the 
ball  had  passed  had  been  overlooked  during  the  V.'e  of  the  patient, 
and  that  this  was  the  real  cause  of  death.  But  our  astonishment 
was  increased  when,  after  a  careful  examination  of  the  surface,  no 
opening  could  be  found.  As  a  last  resort,  the  cranitim  was  exam- 
ined from  the  interior,  and  on  the  anterior  surface,  above  and  a  lit- 
tle to  the  right  of  the  left  orbit,  was  found  a  fracture  of  the  frontal 
bone,  the  internal  table  of  which  was  extensively  fissured.  With 
this  as  a  guide,  we  again  made  search  for  the  external  aperture, 
and  again  failed  in  finding  an  opening,  but  finding  a  discoloration 
of  the  skin  over  the  seat  of  the  fracture,  of  a  lead  color,  circular  in 
shape,  and  the  size  of  a  balL     There  was  not  the  least  sign  of  a 


28 


i 


wound,  or  the  slightest  pcar.  The  wound,  which  must  have  ex- 
isted, had  healed  perfectly,  and  left  nothing  but  this  leaden  discol- 
oration to  show  its  former  pi-esence.  The  course  of  the  ball 
through  the  brain  could  still  be  traced  by  a  probe  to  the  place 
where  it  had  lodged  near  tlie  anterior  surface  of  the  medulla.  The 
opening  in  the  bone  was  filled  in  with  a  gelatinous  material  through 
which  a  tenaculum  ])as8ed  readily.  There  was  no  previous  historj* 
of  the  case,  but  it  was  evident  that  the  wound  had  been  inflicted  a 
considerable  time  before  death,  and  seeing  the  patient  had  not 
found  refuge  in  a  poor-house,  hospital,  or  asylum,  the  inference  is 
fair  that  the  intellect  had  not  been  much  impaired,  if  any,  up  to 
the  fatal  attack.  I  am  the  more  ready  to  think  so,  from  the  im- 
munity enjoyed  by  patients  similarly  afflicted.  There  could  not 
have  been  serious  functional  results,  as  he  had  been  able  to  look 
after  himself.     The  ])robabilities  are  there  were  no  physical  results. 

A  somewhat  analogous  case  is  recorded  by  Dr. 
Prewitt,  of  the  City  Hospital,  St.  Louis,  {St.  Louis 
Medical  and  Surgical  Journal). 

A  man  aged  32  shot  himself  with  a  pistol.  The  ball  entered  the 
forehead  about  an  inch  and  a  half  above  the  supra-orbital  ridge. 
He  recovered  in  a  little  over  a  month,  and  icithout  marked  impair- 
ment of  intellect.  He  died  eleven  months  afterwards  from  erysip- 
elas.    No  functional  impairment  is  mentioned. 

Assistant  Sui'geon  P.  F.  Harvey,  U.  S.  A.,  reports 
the  following  case,  (vide  American  Journal  of  the 
Medicai  Sciences^  July?  1870).  It  is  that  of  an  Indian 
Agency  physician,  who  received  a  Winchester  rifle  ball 
three  inches  and  a  quarter  above,  and  one  inch  behind 
the  right  external  auditory  meatus.  The  missile  took 
a  transverse  direction,  across  both  hemispheres,  toward 
the  left  supra-orbital  convolution.  A  grooved  director 
was  easily  passed  in  this  track,  a  distance  of  five  inches, 
without,  however,  reaching  the  ball.  The  patient  did 
not  lose  consciousness  on  being  wounded,  and  com- 
plained only  of  "seeing  stars,"  and  of  some  confusion 
of  ideas.  He  recovered  so  rapidly  that  after  five  days 
of  convalescence  he  took  a  journey  of  ninety  miles,  iu 


fl 


24 


December,  in  an  open  buggy,  alighting  several  times  to 
make  his  way  on  foot  through  deep  snow  drifts.  At 
the  end  of  this  exertion,  however,  two  convulsions 
occurred,  and  the  wound  in  the  head  re-opened.  In  a 
short  time  complete  convalescence  eiisued.  Six  months 
after  the  wounding,  the  patient  traveled  across  the 
plains  to  his  home  in  Indianapolis,  and  on  his  arrival 
reported  himself  in  excellent  condition. 

Dr.  Hopwood,  of  Ashton-under-Lyme  District  In- 
firmary, England,  gives,  in  the  London  Lancet,  an 
account  of  a  case  under  his  care  last  summer. 

A  male  patient,  aged  28,  was  engaged  in  removing  the  center 
support  of  the  arch  of  a  brick  kiln,  and  before  he  could  get  out  of 
the  way  the  arch  fell,  burying  him  and  several  others  in  the  ruins. 
All  the  bones  of  lie  face  were  crushed  in,  and  among  other  injuries 
the  coronoid  process  of  the  lower  jaw  was  broken  off,  and  there 
was  a  depressed  fracture  of  the  temporal  bono,  just  above  the 
zygoma,  from  which  the  brain  protruded  to  about  the  size  of 
a  strawberry.  The  coronoid  process  of  the  lower  jaw,  and  the 
zygoma,  were  removed,  the  protruding  brain  matter  was  shaved 
off,  and  the  temporal  bone  elevated.  Temperature  at  this  time 
was  99°  Fahrenheit ;  pulse  62.  The  patient  was  perfectly  sensible 
when  brought  to  the  Infirmary,  and  thought  he  was  only  slightly 
hurt.  There  was  no  shock,  nor  had  there  been  any.  The  pupils 
were  perfectly  regular  and  there  was  no  paralysis.  There  was  no 
mental  disturbance  at  any  time,  and  ten  days  after  the  injury  he 
said  "he  felt  as  well  as  ever  he  did  in  his  life."  The  injury  was 
inflicted  on  30th  July,  1879,  and  on  October  14th,  following,  he 
was  quite  well  and  working  regularly. 

John  MiicEvoy,  of  Paterson,  N.  J.,  a  lad  of  fifteen 
years  of  age,  was  gathering  saw-dust  in  a  saw-mill,  last 
December.  He  had  crawled  under  a  circular  saw, 
going  at  a  speed  of  2,500  revolutions  a  minute.  The 
saw  was  twelve  inches  in  diameter  and  nine  inches  of  this 
was  under  the  table.  Becoming  startled  by  a  noise  the 
boy  suddenly  raised  his  head,  bringing  it  in  contact 
with  the  saw.    The  saw  had  made  a  clean  sweep  from 


25 


4 


the  upper  part  of  the  frontal  bone  to  the  right  side  of 
the  nose.     The  right  upper  eyelid  was  completely  sev- 
ered, but  the  eyeball  was  untouched.     The  cut  was 
three-sixteenths  of  an  inch  wide,  and  the  edges  of  the 
wound  were  smooth.     The  boy  was  able  afterwards  to 
walk     rd  told  how  the  accident  had  happened.     He 
appct      I  to  the  physician  to  save  his  life,  saying  that 
lie  did  not  want  to  die.     During  the  dressing  of  the 
wound  the  boy  straightened  up  several  times,  and  the 
physicians  were  obliged  to  tell  him  repeatedly  to  lie 
still ;  he  obeyed  as  readily  as  a  well  person  would  and 
understood  what  was  required  of  him.     He  took  in  his 
hand  a  glass  of  whiskey  which  was  given  to  him,  which 
he  drank  without  assistancce.     The  accident  happened 
on  Monday,  and  during  the  week  his  intellect  remained 
unimpaired  until  Saturday,  when   convulsions  set   in 
and  he  died.     No  ^w.9^  mortem  was  allowed  by  the 
parents,  so  the  exact  extent  of  the  injury  could  not  be 
ascertained.     No  functional  impairment  was  seen  until 
the  boy  was  dying.     Taking  the  extent  of  the  surface 
wound  as  a  basis  of  conjecture,  or  speaking  mathematic- 
ally, calculating  the  segment  of  a  circle,  the  deepest  ser- 
rated rim  of  the  saw  must  have  entered  at  least  two 
inches  into  the  skull  and  brain  together.     The  cut  was  as 
clean  as  if  done  with  a  sabre,  and  was  no  doubt  done 
almost  as  rapidly.     Towards  the  end  paralysis  set  in, 
but,  strange  to  say,  the  medical  men  differed  as  to  which 
side   or  limbs  were   paralyzed.     Dr.    Quin,  the  Chief 
Surgeon  of  the  hospital  where  the  boy  lay,  gives  another 
case  which  came  under  his  notice  years  before.     There 
was  a  boy  named  Murphy,  who  fell  out  of  a  window 
of  considerable  height,  upon  the  curbstone  in  the  street. 
He  struck  it  with  his  forehead.     When  he  was  picked 
up  more  than  a  teaspoonful  of  brain  matter  oozed  out 
of  his  head.     He  got  well  physically  and  mentally,  and 


26 


'   t 


N 


]ived  to  be  twenty -two  years  old  although  he  was  only 
five  years  at  the  time  of  the  accident.  There  was  no 
paralysis. 

Of  another  case  the  doctor  says:  "There  is  Joe. 
Murphy,  you  may  see  him  almost  any  day  walking 
round  the  streets  hei'e.  He  is  lame  and  di'ags  one 
foot  a  little.  One  day  in  1864  I  was  going  along  the 
street,  when  some  people  came  running  after  me.  1 
went  into  a  basement  and  found  Joe.  Muiphy  had  been 
shot  in  the  right  eye,  two  minutes  before,  with  a  bullet 
38.900  calibre.  I  probed  the  wound  and  found  the 
bullet  flattened  against  the  back  of  his  skull.  It  is 
there  yet.  But  Joe.  got  well,  and  his  mental  facultieft 
are  unimpaired.  I've  been  intending  to  make  a  post 
mortem  examination  of  his  head,  but  I  begin  to  think 
the  old  man  will  outlive  me." 

In  the  Canada  Lancet,  of  April,  1872,  Dr.  T.  R. 
Dupuis,  of  Kingston,  Ont.,  states  the  case  of  a  boy  who 
had  been  injured  by  a  fall  from  a  horse  while  going  at 
a  rapid  rate.  The  lesion  was  a  compound  fracture  at 
the  middle  of  the  superior  portion  of  the  left  parietal 
bone,  with  considerable  laceration  of  the  brain.  The 
broken  piece  of  bone  was  nearly  an  inch  and  three- 
quarters  long,  three-quarters  of  an  inch  broad  at  one 
end  and  three  eighths  of  an  inch  at  the  other.  One 
edge  of  this  piece  was  driven  down  into  the  brain  in 
such  a  manner  that  its  surfaces  occupied  a  position  per- 
pendicular to  their  original  situation,  while  the  other 
edge  remained  in  situ,  being  still  attached  to  the  solid 
bone  by  the  dura  mater,  which  formed  a  sort  of  hinge, 
upon  which  the  fragment  turned.  The  history  of  the 
case  states  that  the  injury  had  been  inflicted  by  the 
sharp  edge  of  a  stone.  After  exploring  the  wound  with 
the  points  of  the  fingers,  which  passed  in  readily  to  the 
depth  of   half  an   inch   or   more,   the   fragment   waa 


,. 


27 


extracted  by  means  of  a  forceps.  Nearly  a  tablespoon- 
ful  of  brain  substance  was  lost.  At  first  the  patient 
was  comatose.  This  state  continued  for  two  days.  At 
the  end  of  the  second  day  he  had  lucid  intervals.  On 
the  third  day  consciousness  began  to  return,  and  with 
it  voluntary  motion.  At  this  time  the  wound  was  dis- 
charging disintegrated  brain  matter  mixed  with  grum- 
ous  blood  and  pus.  Thirteen  days  after  the  accident 
the  delirium  was  gone,  but  the  mind  was  fickle,  the 
temper  irritable  and  caj  licious.  Without  entering 
into  the  whole  history  of  the  case  as  given,  it  may 
be  said,  the  Doctor  adds,  "a  month  .after  this  lesion 
had  taken  place  all  effects  of  this  severe  injury  had 
passed  away,  except  a  slight  puffy  appearance  about  the 
face,  a  little  clumsiness  in  his  movements  and  some 
irritability  of  temper."  Since  that  time  he  became  as 
healthy  and  strong  as  he  ever  was.  The  patient  was 
closely  watched  during  the  course  of  his  illness,  but  the 
Doctor  failed  to  detect  any  morbid  mental  manifesta- 
tions that  seemed  to  indicate  injury  to  any  distinct 
phrenological  development.  It  will  be  seen  that  no 
disturbance  of  functions  took  place  commensurate  with 
the  injury,  nor  were  they  such  as  would  be  expected 
bv  the  school  of  cerebral  localizers. 

In  the  Montreal  Hospital  Reports  of  1879  we  have 
two  cases  recorded.  The  first  is  a  case  of  a  wound  in- 
flicted by  a  swiftly  revolving  circular  wood-saw.  It 
produced  a  serious  lesion  in  the  central  part  of  the  first 
and  second  frontal  convolutions  on  the  left  side.  The 
skull  wound  extended  in  an  oblique  direction  from 
above  the  outer  angle  of  the  left  orbit  across  the  fron- 
tal, through  the  anterior  superior  angle  of  the  right 
parietal  and  terminated  about  the  center  of  this  bone. 
It  had  penetrated  through  the  membranes,  and  at  the 
central  part  the  brain  substance  was  lacerated  and  ex- 


28 

posed,  and  could  be  seen  pulsating.  The  post  mortem 
revealed  a  large  rent  extending  from  the  longitudinal 
sinus  downwards  and  outward  to  a  point  a  little  ante- 
rior to  the  beginning  of  the  fissure  of  Sylvius.  The 
central  portions  of  the  first  and  second  left  frontal  con- 
volutions were  completely  destroyed.  The  patient  was 
unconscious  for  about  ten  minutes  after  the  accident, 
but  when  taken  to  the  Hospital  became  quite  conscious^ 
and  at  that  time  had  no  paralysis,  nor  are  we  told  that 
either  one  or  the  other  supervened  before  death,  which 
took  place  two  days  after  the  accident. 

In  the  same  Hospital  Keports  the  history  of  a  second 
case  is  given.  A  young  man,  aged  22,  was  accidentally 
shot  by  the  discharge  of  a  pistol.  The  bullet  entered 
the  skull  above  and  a  little  in  front  of  the  right  ear. 
From  the  first  he  was  perfectly  conscious,  not  paralyzed^ 
and  gave  a  rational  account  of  how  it  happened.  A 
probe  was  inserted  into  the  wound,  and  it  passed  freely 
into  the  frontal  lobe  in  the  course  of  the  bullet.  Pulse 
6.0.  No  elevation  of  temperature.  The  accident  hap- 
pened March  8th,  and  he  died  of  consumption  August 
12th  following,  but  between  these  two  periods  there 
was  no  unusual  mental  disturbance.  Without  giving 
the  details  of  the  autopsy  suffice  it  to  say,  that  the  bul- 
let entered  the  brain  substance  in  the  right  inferior 
frontal  convolution,  just  in  front  of  the  ascending 
branch  of  the  Sylvian  fissure.  From  this  point  the 
course  of  the  bullet  was  upwards  and  forwards,  passing 
out  at  the  inner  surface  of  the  frontal  lobe  and  lodging 
between  the  brain  substance  and  the  falx,  where  it  lay 
surrounded  by  a  firm  membrane.  A  firm  membranous 
canal  marked  the  course  of  the  bullet,  and  the  brain 
substance  about  this  was  somewhat  softened.  This  ex- 
tensive destruction  of  brain  tissue  did  not  disturb  the 
mind. 


' 


■1 


29 


V     r 


M.  Flourens,  of  Paris,  some  years  ago  experimented 
on  animals,  not  only  to  show  the  curability  of  brain 
substance,  but  also  to   demonstrate  how  much    brain 
tissue  cau  le  injured  without  the  untoward  physical 
and  mental  results  formerly  apprehended  and  dreaded. 
He  trepanned  the  skulls  of  dogs  and  rabbits,  made  a 
small  opening  in  the  dura  mater  and  into  the  substance 
of  the   brain,  and   then  put  bullets  into  the  wound- 
These  bullets  gradually  penetrated  through  the  cerebral 
matter  by  their  own  weight.     When  the  ball  was  small, 
he  found  that  the  whole  thickness  of  the  lobe  of  the 
brain  or  of  the  cerebellum  might  be  traversed  by  it 
without  occasioning    any  symptom,  or  disturbance  of 
function.     The  fissure  made  by  the  passage  of  the  ball 
remains  for  some  time  as  a  canal;  it  then  closes  up  and 
cicatrizes.     (JO  Union  Medleale^  1863). 

Dr.  Thomas,  surgeon  to  St.  Bartholomew's  Hospital^ 
London,  gives  in  the  London  Lancet  of  January  last, 
an  interesting  case,  in  which  the  patient  made  a  good 
recovery  without  loss  of  mental  or  physical  power.     A 
man  thirty-five  years  of  age,  shot  himself  with  a  revolver 
through  the  head.     The  bidlet  passed  in  at  one  temple 
and  out  at  the  other.     Half  an  hour  after  the  accident 
the  pupils  were  found  to  be  natural,  pulse  feeble,  and 
respiration  natural.     The  patient  was  quite  conscious, 
and  answered  questions  correctly  concerning  his  name, 
age,  and  address,  and  of  his  own  accord.     He  was  an 
educated  man  and  spoke  in  German,  but  when  addressed 
in  either  French  or  English  he  would  reply  in  the  cor- 
responding language.     He  showed  no  signs  of  mental 
incapacity,  nor  was  there  any  loss  of  motor  power.     He 
vomited  a  good  deal  at  first,  and  at  that  time  blood  and 
cerebral  substance  were  forced  from  the  wound  in  the 
right  temple.     For  several  days  he  became  quite  irrita- 
ble, and  had  a  few  delusions,  but  no  functional  depriv- 


80 


ation.  On  tlie  forty-third  day  after  the  wound  was  in- 
flicted he  became  quite  well.  At  firnt  a  probe  was 
passed  its  whole  length  into  the  wound  and  across  the 
head  without  meeting  the  slightest  resistance.  At  first 
the  special  senses  were  very  slightly  impaired,  but  all 
recovered  their  tone  before  he  left  the  hosj)ital,  except 
the  sight,  which  was  slightly  impaircMl.  As  regards 
the  course  of  the  bullet  in  this  case,  Dr.  Smith  says:  "It 
is  certain,  fiom  the  position  of  the  apertures  of  entrance 
and  exit,  that  it  entered  the  outer  surface  of  the  ante- 
rior lobe  of  the  brain,  a  little  above  the  level  of  the 
highest  part  of  the  roof  of  the  orbit,  and  that  it  emerged 
from  the  left  anterior  hemisphere  at  a  spot  rather  farther 
back  and  at  a  slightly  higher  level."  From  the  large 
effusion  of  blood  in  both  orbits,  which  so  rapidly  fol- 
lowed the  injury,  there  is  reason  to  believe  that  in  its 
passage  across  the  skull  the  bullet  fractured  the  roof  of 
both  these  cavities.  From  the  free  and  persistent  epis- 
taxis,  it  is  probable  that  the  cribriform  plate  of  the 
ethmoid  or  some  part  of  the  roof  of  the  nasal  cavity  was 
broken  into,  while  there  was  evidence,  from  the  symp- 
toms, that  the  olfactory  bulbs  did  not  escape  disturb- 
ance or  injury.  It  may  be  said  that  there  is  no  direct 
proof  that  the  left  hemisphere  of  the  brain  was  wounded 
at  all,  that  the  bullet  may  have  run  over  the  roof  of  the 
left  orbit  and  up  the  inside  of  the  skull  to  its  point  of 
exit  from  the  bone.  The  surgeon  is  sure,  however,  that 
the  probe  traversed,  without  any  sensation  of  resistance, 
both  hemispheres,  and  one  would  think  it  impossible 
that  a  bullet  of  the  size  and  weight  indicated,  after 
passing  through  one  side  of  the  skull,  could  have 
knocked  a  piece  of  bone  clean  out  of  the  opposite  side 
unless  it  impinged  upon  the  inner  surface  of  the  bone 
in  a  direct  line.  As  further  proof  pulsation  and  respi- 
ratory movements  were  observed  in  the  blood  tumor 


31 


over  the  aperture  of  exit,  and  these  were  so  forcible  as 
to  indicate  that  the  interior  of  the  brain  was  in  direct 
contact  with  the  ecchymosis.  It  is  certain  that  the 
part  of  tlie  hennshi)heres  that  was  damaged  was  the 
anterior  frontal  portion  just  above  the  orbits.  Has  this 
part  any  functional  center?  If  so,  where  is  the  evi- 
dence of  its  ])eing  necessary,  seeing  tliat  both  frontal 
lobes  were  injured  seriously,  without  any  immediate  re- 
sults in  proportion  to  the  lesion  inflicted  ?  Is  this  an 
.  organization  put  in  more  to  fill  up,  than  to  be  of  use  to 
its  neighbors?  I  had  the  impression  nature  had  no 
garret  filled  with  useless  furniture.  Some  functional 
centers  must  have  been  badly  broken  up  by  this  de- 
structive intruder. 

About  seventeen  years  ago  I  was  called  to  visit  a 
boy,  aged  thirteen,  who  had  been  kicked   by  a  horse. 
A  section  of  the  skull  was  crushed  in  on  the  right  side, 
near  the  median  line,  in  the  upper  part  of  the  frontal 
and  })arietal   bones.     One  of  the  nine  pieces  fractured 
and   detached  from  the   surrounding  bone,  had  been 
driven  into  the  substance  of  the  brain,  over  an  inch  in  a 
perpendicular  direction.     The   membranes  were  lacer- 
ated  very   much,  and   brain   substance,  within  a  few 
grains  of  an  ounce  in  weight,  protruded  through  the 
wound  much" broken  up,  some  of  it  hanging  down  upon 
his  cheek.     At  the  time  I  first  saw  him  he  was  co- 
matose.    I  extracted  the  bones ;  cut  awa}'  the  ragged 
edges  of  the  membranes,  and  the  lacerated  brain  sub- 
stance.     Consciousness    returned    immediatelv.      His 
temperature  remained  normal ;  his  pulse  did  not  rise  at 
any  time  above  96 ;  he  did  not  lose  a  night's  sleep  nor 
a  meal  after  the  evening  of  the  accident.     No  febrile 
symptoms  intervened;  there  was  no  paralysis,  nor  per- 
version of  any  of  the  organs  of  special  sense ;  there  was 
no  difficulty  in  speaking.     A  large  cavity  remained. 


I 


83 


J 


1 

ii 


He  afterwards  went  to  school  to  the  same  mistress  as 
before,  and  slie  informed  me  that  witli  the  exeepticm  of 
a  certain  irritability  of  temper  wlien  tliwarted,  (vvliich 
he  did  not  possess  bel'ore),  he  was  as  intelligent  as  ever, 
and  could  learn  his  lessons  with  his  usual  aptitude. 
Tliis  was  especially  noticeable  in  mental  aritlnnetical 
exercises.  He  was  under  my  observatioli  for  several 
years  after  the  accident.  After  he  was  aroused  from 
his  comatose  condition  consequent  on  comj^ression,  his 
special  senses  were  unimpaire;! ;  his  locomotive  and 
grasping  powers  normal,  and  his  bodily  health  good  in 
every  ])articular. 

These  examples  might  be  indefinitely  extended. 
Medical  liteiature  is  full  of  evidences  of  destruction  to 
the  brain  matter  of  the  cerebrum  and  cerebellum  with- 
out any  serious  impairment  of  menial  power  or  phys- 
ical function.  Let  a  brain  be  taken  and  wires  passed 
through  it  to  indicate  the  corise  of  the  missiles  in 
these  cases  I  have  mentioned,  and  it  will  be  seen 
that  brain  substance  has  been  injured  in  almost 
every  conceivable  direction,  yet,  with  no  physical 
or  mental  results  at  all  commensurate  with  the 
lesions  inflicted.  If  these  parts  are  motor  centers, 
then  have  we  the  miraculous  phenomena  of  organic  op- 
erations without  an  organ — of  varied  and  distinct  func- 
tions without  a  motive  power,  and  of  uniform  results 
without  an  efficient  cause.  Were  we  even  to  consider 
the  brain  a  dual  organ  the  difficulty  would  remain, 
where  corresponding  sides  are  simultaneously  injured. 
In  all  the  dual  organs  of  the  body  we  find,  sudden  in- 
jury to  one  is  always  followed  by  imperfect  work  in  its 
fellow,  until  time  is  given  to  allow  provision  to  be  made 
for  the  extra  labor  imposed.  When  we  find  no  impair- 
ment in  function  consequent  on  destruction  of  one  so- 


iii^sximimm- 


33 


culled  motor  center,  we  ure  led  by  uiiiforiii  aiuilogy  to 
doubt  a  doeirine  ho  anoinaloua  and  contradictory.  At 
least  it  is  l)eHt  to  accept  with  caution  a  theory  whicli  is 
being  accepted  based  upon  exceptional  examples,  and 
which  does  not  account  for  the  physical  results  except 
in  isolated  cases.  Tht^  mental  eftects  seen,  as  consequent 
upon  brain  injury,  would  prove  too  j)rolific  a  theme  for 
present  investigation. 


T 


THE 


AMERICAN  JOURNAL  OF  INSANITY. 


•♦•♦■■ 


The  Amkrican  Jouknai,  of  Insanity  ih  published  <inarterly,  at  the 
State  Lunatic  A«ylum,  Utica,  N.  Y.  'V\w  first  number  of  each  volumfl 
Ih  irtrtued  in  July. 

Kditok, 
JOHN  W  GRAY,  M.  I).,  LL.  I).,  Medical  Superintendent. 

Associate  Editors, 
EDWAUT)  N.  BRITSII,  M.  D., 
SELWYN  A.  UUSSELL,  M.  I)., 
ELI  E.  JOSSELYN,  M.  D., 
G.  ALDER  BLLTMEK,  xM.  J)., 


Assistant  Physicians 


THEODORE  DEECKE,  Special  Pathologist. 


TERMS   OF   SUBSCRIPTION 


P^'ive  Dollars  per  -A^iirium,  in  i^dvance. 


Exchanges,  Books  for  Review,  and  Business  Communications 
may  be  sent  to  the  Editor,  directed  as  follows :  "  Journal  of 
Ins.  nity,  State  Lunatic  Asylum,  Utica,  N.  Y." 

The  Journal  is  now  in  its  thirty-seventh  volume.  It  was  es- 
tablished by  the  late  Dr.  Brigham,  the  first  Superintendent  of  the  New 
York  State  Lunatic  Asylum,  and  after  his  death  edited  by  Dr.  T.  Ro- 
meyn  Beck,  author  pf  "  Beck's  Medical  Jurisprudence ;"  and  since  1864, 
by  Dr.  John  P.  Gray,  and  the  Medical  Staif  of  the  Asylum.  It  is  the 
oldest  journal  devoted  especially  to  Insanity,  its  Treatment,  Juris- 
prudence, &c.,  and  is  particularly  valuable  to  the  medical  and  legal 
professions,  and  to  all  interest*  d  in  the  subject  of  Insanity  and  Psy- 
chological Science. 


I* 


■a 


m 


